摘要目的:探讨多层螺旋CT血管造影在主动脉夹层临床诊断中的应用价值。方法:回顾性分析舟山市普陀区人民医院和舟山医院2015年1月至2019年12月收治并经数字减影血管造影检查确诊为主动脉夹层患者78例的临床资料，均采用多层螺旋CT血管造影和数字减影血管造影检查，比较两种检查方法对主动脉夹层各种分型、主动脉破口数、破口处距左锁骨下动脉距离、累及分支血管、动脉壁钙化率及动脉夹层血栓等检出情况。结果:78例患者经数字减影血管造影检查均确诊为主动脉夹层，多层螺旋CT血管造影检出75例（96.2%），分型与数字减影血管造影相同，有3例误诊为心包炎。两种方法在检查主动脉破口数、破口处距左锁骨下动脉距离等差异均无统计学意义（ t=1.02、0.57，均 P>0.05），而多层螺旋CT血管造影累及分支血管61.3%（46/78）、动脉壁钙化率26.7%（20/78）、动脉夹层血栓检出率78.7%（59/78），均高于数字减影血管造影的43.6%（34/75）、12.8%（10/75）、62.8%（49/75），两组差异均有统计学意义（χ 2=4.83、4.65、4.62，均 P<0.05）。 结论:多层螺旋CT血管造影对主动脉夹层的检出率与数字减影血管造影接近，能准确检出主动脉破口数和破口位置，还能显示血管壁的钙化和血栓情况，且具有无创、操作简便的特点，在主动脉夹层的临床诊断和术前评估中有较高的应用价值。

abstractsObjective:To investigate the application value of multi-slice spiral CT angiography in the clinical diagnosis of aortic dissection.Methods:The clinical data of 78 patients with aortic dissection diagnosed by digital subtraction angiography and treated between January 2015 and December 2019 in Putuo District People's Hospital of Zhoushan and Zhoushan Hospital were retrospectively analyzed. All patients underwent multi-slice spiral CT angiography and digital subtraction angiography. The type of aortic dissection, the number of aortic lacunas, the distance between the lacuna and the left subclavian artery, the involved branches, the percentage of artery wall calcification, and arterial dissection thrombosis determined by multi-slice spiral CT angiography and digital subtraction angiography were compared.Results:All 78 patients were diagnosed with aortic dissection by digital subtraction angiography, and 75 (96.2%) were diagnosed with aortic dissection by multi-slice spiral CT angiography. The same type of aortic dissection was detected by multi-slice spiral CT angiography and digital subtraction angiography, but three patients were misdiagnosed with pericarditis by multi-slice spiral CT angiography. There were no significant differences in the number of aortic lacunas and the distance between the lacuna and the left subclavian artery between the two methods ( t = 1.02, 0.57, both P > 0.05). The involved branches [61.3% (46/78),] the percentage of artery wall calcification [26.7% (20/78)], and the percentage of arterial dissection thrombosis [78.7% (59/78)] determined by multi-slice spiral CT angiography were significantly higher than 43.6% (34/75), 12.8% (10/75), and 62.8% (49/75) respectively determined by digital subtraction angiography ( χ2 = 4.83, 4.65, 4.62, all P < 0.05). Conclusion:Multi-slice spiral CT angiography exhibits a similar capacity to identify aortic dissection to digital subtraction angiography. It can accurately determine the number and location of aortic lacunas, display the calcification and thrombosis of vascular wall, and is minimally invasive and simply operated. Therefore, multi-slice spiral CT angiography is of high application value in the clinical diagnosis and preoperative evaluation of aortic dissection.